Dying mothers should shock Texas into action

1of2State Rep. Shawn Thierry, D-Houston, speaks about her House Bill 11, relating to pregnancy-related deaths and maternal morbidityat the Texas Capitol in Austin. The poster is photos of mothers who have died during child birth. Thierry read the names of mothers who had died as she dedicated her bill to their memory.Photo: Stephen Spillman / For the Express-News

That's what Houston state Rep. Shawn Thierry said on the House floor this past week. She was quoting her grandmother, born in 1920.

"Here we are, a century later in Texas," Thierry said. And for an alarming number of women, the saying is still true.

Texas has the highest rate, by far, of maternal mortality in the nation. And, with the exception of Mexico, Texas has the highest rate in the developed world.

Let that sink in.

In a state that boasts the world-renowned Texas Medical Center, a state where "pro-life" is a battle cry of powerful elected leaders, women are dying at troubling rates before, during and after giving birth from conditions such as hypertension, pre-eclampsia, sepsis and hemorrhage.

Good news came last week when Thierry, a Democrat, joined a bipartisan group of lawmakers to pass several bills out of the House that attempt to tackle the problem by, among other things, extending the life of a state task force studying it and improving data collection.

It was a bright moment in a bitterly divisive special session in Austin, but it was far too long in coming. State Rep. Armando Walle said he was alerted to the problem back in 2010 by Houston-area doctors. He filed his first bill to study the issue in 2011, and it went nowhere. Finally, in 2013, with bipartisan support, he helped pass a bill to establish the Texas Mortality and Morbidity Task Force, but it took more than a year to set it up.

Bills to give the task force more time, until 2023, to do its work and more resources were added to the special session by Gov. Greg Abbott, signifying that maternal mortality is a priority for the governor.

But how much of a priority?

It's one thing to study the issue. It's another to save women's lives.

Granted, this is a complex issue. The national media sometimes tries to portray it as the direct consequence of Texas' crusades against abortion rights and Planned Parenthood, which led to widespread clinic closures, and its draconian slashing of family planning funding in 2011.

But maternal mortality rates have risen nationwide, with black women bearing the greatest risk. It's a trend that is much worse in Texas but that began before the 2011 cuts.

Even Walle, a Houston Democrat, admits it's not a clear connection.

"A lot of reporters call me and ask me that question. As somebody who is as progressive on health care as anybody, I would truly like to find a way to make that argument. But it would be illegitimate on my part. I'd lose my credibility," he said. "The timelines don't match up."

Rate significantly high

Dr. Lisa Hollier, medical director of obstetrics and gynecology at Texas Children's Hospital who leads the state task force, said there's no one cause, and she points out that the Texas rate has dipped a bit in recent years.

"The rates are still over 30 per 100,000, which is still significantly greater than most other states," she said.

What is clear is that the best way to prevent pregnancy-related deaths is to improve access to health services. It was the No. 1 recommendation in a report by the task force last year. To increase access during the year after delivery, to improve continuity of care, promote birth spacing, among other suggestions.

And there's the rub.

Texas continues to lead in the nation in the number of uninsured. The rate fell from 25 percent to 16.8 percent in 2015, thanks to the Affordable Care Act, but we're still far worse than the national average, now in single digits.

Screen for problems

Studies suggest the number of Texas women once covered by a state-federal Medicaid program for reproductive care has plummeted since the state dropped Planned Parenthood from it in 2011. Lawmakers have prohibited the state from paying for abortions, but also have ostracized the century-old family planning agency for performing the procedure at all.

The move violated federal rules, costing Texas tens of millions in federal dollars per year, and provider networks collapsed as the state scrambled to create - and fund - its own program, Healthy Texas Women.

One positive development is that new mothers are no longer left scrambling for a doctor after their Medicaid coverage ends, 60 days after childbirth. With some exceptions, women are now automatically enrolled into the state's program, where they can be screened for chronic conditions, such as hypertension, and have access to limited treatment for postpartum depression, according to a spokeswoman with the Health and Human Services Commission.

Still, nearly 45,000 fewer Texas women receive state health services since 2011, according to a report released last week by the Austin-based Center for Public Policy Priorities, which advocates for low-income Texans.

Other studies have shown declines in access to contraception and a rise in Medicaid-paid births.

With this backdrop, the fight against maternal mortality would seem Sisyphean. What's the use of studying the issue when we already know our best weapon - improving access to care - is something some conservatives are loathe to support, at least openly?

Unless.

Unless the reality of Texas mothers dying preventable deaths, most of them nearly a year after delivery, is enough to change minds.

Progress gives hope

Hollier, the physician, isn't sure.

"I don't know if this is going to be the issue that changes the way we provide health care in Texas," she said. But in the meantime, Hollier said her clinic for at-risk pregnancy has already begun implementing solutions that don't need legislative approval. Risks from hemorrhaging, for instance, can be prevented by testing for anemia in advance, injecting iron intravenously, and having doctors lead drills in hospitals to hasten response times.

That kind of progress gives Walle hope, and so does all the attention the issue has gotten lately.

"Maybe this is a spark," he said. "I think it will take a couple of sessions to convince some folks, but the facts are the facts. If we don't address access to care, then we will continue to see a rise in maternal deaths. I don't think anybody would argue with that."

At least, nobody should. If the problem is truly a priority for state leaders, then the solution should be, too.

Lisa Falkenberg is the Chronicle’s vice president/editor of opinion. A Pulitzer Prize-winning journalist with more than 20 years’ experience, Falkenberg leads the editorial board and the paper’s opinion and outlook sections, including letters, op-eds and Gray Matters.

Falkenberg wrote a metro column at the Chronicle for more than a decade that explored a range of topics, including education, criminal justice and state, local and national politics. In 2015, Falkenberg was awarded the Pulitzer for commentary, as well as the American Society of News Editors’ Mike Royko Award for Commentary/Column Writing for a series that exposed a wrongful conviction in a death case and led Texas lawmakers to reform the grand jury system. She was a Pulitzer finalist in 2014.

Raised in Seguin, Texas, Falkenberg is the daughter of a truck driver and a homemaker, and the first in her family to go to college. She earned a journalism degree from the University of Texas at Austin in 2000. She started her career at The Associated Press, working in the Austin and Dallas bureaus. In 2004, Falkenberg was named Texas AP Writer of the Year.

She joined the Chronicle in 2007 as a roving state correspondent based in Austin.

Falkenberg has mentored journalism students through the Chronicle’s high school journalism program and volunteered with the News Literacy Project. She is a fellow with the British-American Project and has completed a fellowship at Loyola’s Journalist Law School in Los Angeles.